Pain In Cancer Patients Research Articles

The positive significance of staged physical mental combined pain reduction nursing based on pain scoring for cancer pain patient

AbstractTo observe the positive of stage‐based physical mental combined pain reduction nursing based on pain scoring for cancer pain patients. A total of 120 cancer pain patients admitted to our hospital from December 2022 to December 2023 were selected. They were randomly divided into a control group and an observation group, with 60 cases in each group. The control group received medication intervention nursing, whereas the observation group received phased physical mental combined pain reduction nursing. The visual analogue scale (VAS) pain scores, Psychological Hope Level (HHI) score and Psychological Health Mood State Questionnaire (POMS) score of the two groups of patients were observed before nursing and at 1, 6, and 12 months after nursing. There was no difference in VAS scores between two groups at 1 month after nursing care (p > 0.05), but the observation group had lower VAS scores at 1, 6, and 12 months after nursing; In the HHI score of the observation group patients after nursing, there was no difference between the pre‐nursing and 1 month post nursing scores and the control group (p > 0.05), but scores were lower than the control group at 6 and 12 months after nursing; The POMS score of the observation group patients after nursing was better than the control group. All the difference was statistically significant (p < 0.05). Our findings suggest that staged physical mental combined pain reducing care has a positive impact on patients with cancer pain.

Analgesic efficacy of sacral neuromodulation for chronic pelvic cancer pain

Background: Neuromodulation has provided promising results in chronic pain management. Sacral neurostimulation (SNS) is a neuromodulatory technique, where the sacral nerve roots are electrically stimulated. Objective: Evaluate the efficacy of the trial phase to control severe cancer pain in pelvic organs. Design: Pilot study. Methods: Chronic pelvic cancer pain patients were managed with morphine ≥ 60 mg daily, duloxetine 30 mg, and celecoxib 200 mg twice daily. Twenty-two adults were divided randomly into two equal groups: the SNS group (N = 11), received a sacral neurostimulator device and opioid analgesics, and the opioid group (N = 11), received increased opioid analgesics to control pain. Results: Visual analog scale scores were decreased in the SNS group at 24 h, 4 days, 1, and 2 weeks in SNS compared to the opioid group, medians (IQR) [4 (3–5) vs 6 (5–7), 3 (3–4) vs 5 (5–6), 3 (3–4) vs 5 (5–6), and 3 (3–3) vs 5 (4–6) P < 0.001], daily morphine consumption was reduced in the SNS group compared to the opioid group, median (IQR) [90 (60–90) mg vs 120 (120–150) mg, P < 0.001] and [30 (30–60) mg vs 150 (120–180) mg] during the first and second weeks. The SNS group had a better life quality compared to the opioid group after 2 weeks, median (IQR) was (123 (122.5–124) vs 117 (117–118.5) P < 0.001), respectively. Conclusion: The SNS trial device showed effectiveness in managing severe chronic pelvic cancer pain.

A pilot study of precision treatment for patients with lung cancer pain by Longteng Tongluo recipe using serum genomics.

To investigate the efficacy of Longteng Tongluo recipe (, LTTL) combined with three-step analgesia for the treatment of lung cancer pain, and the changes in serum miRNA expressions before- and after treatment with LTTL and its correlation with lung cancer pain. The possible mechanism underlying LTTL effects on the treatment of lung cancer pain was conducted. The pilot study was conducted at the oncology ward of the Yueyang Hospital and the Longhua Hospital between March 2018 and October 2019. A prospective, single-blind, placebo controlled, randomized clinical trial of LTTL or placebo combined with three-step analgesia treatments were administered to 24 cancer pain patients diagnosed with lung cancer. Analgesic efficacy was investigated as the primary outcome. Equivalent morphine consumption and numerical rating scale (NRS) scores were used as the secondary outcome. In the present study, we utilized deep sequencing techniques to compare the differential miRNA expressions in serum samples obtained from two groups: the lung cancer pain treatment group (LTTL + three-step analgesia) and the control group (placebo + three-step analgesia). Next, we employed the target prediction database to investigate the target genes for differential miRNA expressions and Gene Ontology (GO) analysis along with Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis to examine the roles and the major biochemical and signaling pathways related to the differentially expressed target genes, respectively. LTTL treatment significantly reduces the NRS score (P = 0.021) as compared to those before treatment, along with significant reductions in the total morphine equivalent consumption (P = 0.007) and the average daily equivalent morphine consumption (P = 0.003) as opposed to the control group. The expressions of 31 miRNAs differed considerably between the two groups of patients (≥ 2 times up-modulated or down-regulated between these groups, P<0.05). For instance, the miRNAs expression levels for patients before treatment (has-miR-2110 and has-miR-7d-3p) were significantly enhanced as compared to the healthy people, after LTTL treatment, the expressions of miR-2110 and miR-7d-3p in patients with lung cancer pain reduced significantly. Studies show that the above two miRNAs were significantly associated with lung cancer pain, which could mediate lung cancer pain. Furthermore, we identified 355 genes as potential targets of the 31 differentially expressed miRNAs. Pathway enrichment analyses using KEGG and GO analysis indicated that these target genes may play a crucial role in the development and modulation of lung cancer pain. LTTL demonstrated a discernible impact on alleviating lung cancer pain and its mechanism of action may be related to the downregulation of has-miR-2110 and has-miR-7d-3p expressions. This pilot study provides support for further exploration of LTTL in patients with lung cancer pain.

Inadequate management of opioid-induced constipation in European cancer pain patients: results of a real-world, multicentre, observational study ("E-StOIC").

The objectives of the study were to determine the prevalence of (uncontrolled) OIC, relevant medications / interventions employed by healthcare professionals, and the additional strategies utilised by patients, amongst European patients with cancer pain. This study was a prospective observational study conducted at 24 research sites in ten European countries. Cancer patients receiving opioid analgesics for at least a week were recruited, and asked to complete a questionnaire including background information, single question (Are you constipated?), Rome IV diagnostic criteria for OIC, Bowel Function Index (BFI), and Patient Assessment of Constipation Quality of Life questionnaire (PAC-QOL). Participants were characterised as having / not having OIC on the basis of the Rome IV diagnostic criteria. 1200 participants completed the study. 59.5% met the Rome IV diagnostic criteria for OIC: only 61.5% that met these criteria self-reported constipation. 72% participants were prescribed a regular conventional laxative / peripherally acting mu-opioid receptor antagonist (PAMORA). However, only 66% took their prescribed laxatives every day. Many participants had utilised other strategies / interventions to manage their OIC. Furthermore, 27% had needed to use suppositories, 26.5% had needed to use an enema, and 8% had had a manual evacuation. The use of PAMORAs, and other novel effective medications, was relatively uncommon. The results of this study suggest that management in Europe is often inadequate, and this undoubtedly relates to a combination of inadequate assessment, inappropriate treatment, and inadequate reassessment.

1487P Telemonitoring system effectiveness for alleviating cancer pain in patients with advanced cancer

1487P Telemonitoring system effectiveness for alleviating cancer pain in patients with advanced cancer

AB033. Factors related to neuropathic pain in spinal metastasis tumor patients experiencing cancer pain at Dr. Cipto Mangunkusumo Hospital.

Spinal metastatic tumors are a common complication in advanced cancer patients, frequently leading to debilitating pain that significantly impairs quality of life. Cancer-related pain can encompass various etiologies, including nociceptive and neuropathic components. Neuropathic pain, arising from nerve damage or dysfunction, presents unique challenges in terms of diagnosis and management. Despite its high prevalence in cancer patients, neuropathic pain often remains underrecognized and undertreated. This study aimed to determine the factors related to neuropathic pain in patients with spinal metastatic tumors who experience cancer pain. This study used a retrospective cross-sectional to analyze cancer pain in patients with spinal metastatic tumors. It was conducted at Dr. Cipto Mangunkusumo Hospital using secondary data from January 2023 to January 2024. Prevalence data were calculated using the prevalence formula and expressed as percentages. Normality was assessed using the Kolmogorov-Smirnov test. Chi-square was employed for data management in groups with categorical scales, with Fisher's test used if the requirements for the chi-square test were not met. The study involved 82 patients with spinal metastatic tumors experiencing cancer pain, 51.2% were women. The patients' mean age was 51.5±12.5 years of these patients, 12.2% had lung tumors. The study findings indicate that a significant proportion (73.2%) of patients exhibited tumors with metastases in multiple locations, 61% in thoracal region with the majority (91.5%) experiencing moderate to severe pain intensity. Regarding pain characterization, 9.6% of patients reported neuropathic pain, 47.6% experienced mixed pain, and 42.2% had nociceptive pain. Data analysis found a significant proportion between pain onset (P=0.05), location of lesion (P=0.03), and pain intensity (P=0.01). This study shows patients with spinal metastatic tumors suffering pure neuropathic pain (9.6%) and mixed type pain (47.6%). Pain onset, location of lesion, and pain intensity were significantly different between types of pain. The high incidence of neuropathic pain and mixed pain serves as a crucial reference for treating patients with cancer pain.

Opioid Use and Gut Dysbiosis in Cancer Pain Patients.

Opioids are commonly used for the management of severe chronic cancer pain. Their well-known pharmacological effects on the gastrointestinal system, particularly opioid-induced constipation (OIC), are the most common limiting factors in the optimization of analgesia, and have led to the wide use of laxatives and/or peripherally acting mu-opioid receptor antagonists (PAMORAs). A growing interest has been recently recorded in the possible effects of opioid treatment on the gut microbiota. Preclinical and clinical data, as presented in this review, showed that alterations of the gut microbiota play a role in modulating opioid-mediated analgesia and tolerability, including constipation. Moreover, due to the bidirectional crosstalk between gut bacteria and the central nervous system, gut dysbiosis may be crucial in modulating opioid reward and addictive behavior. The microbiota may also modulate pain regulation and tolerance, by activating microglial cells and inducing the release of inflammatory cytokines and chemokines, which sustain neuroinflammation. In the subset of cancer patients, the clinical meaning of opioid-induced gut dysbiosis, particularly its possible interference with the efficacy of chemotherapy and immunotherapy, is still unclear. Gut dysbiosis could be a new target for treatment in cancer patients. Restoring the physiological amount of specific gut bacteria may represent a promising therapeutic option for managing gastrointestinal symptoms and optimizing analgesia for cancer patients using opioids.

Intrathecal drug delivery systems for cancer pain: A retrospective analysis at a single tertiary medical center in China

ObjectiveIntrathecal drug delivery systems (IDDS) have been clinically applied to treat refractory cancer-related pain for years. In this study, we demonstrate the current clinical practice and outcomes of IDDS for cancer pain management over a 3-year period at a single tertiary medical center in China. MethodsPatients who received IDDS implantation for cancer-related pain from 2021 to 2023 were identified. The electronic medical records of all eligible patients were retrospectively reviewed for study data including baseline characteristics, IDDS variables and postoperative clinical outcomes. ResultsA total of 96 consecutive individuals were identified for analysis and complete follow-up information was available in 72 patients with a follow-up rate of 75 %. Patients were 49.0 % female with a mean age of 62 ± 10 years. The top five cancer types in IDDS population were lung (34.4 %), colorectal (17.7 %), pancreatic (11.5 %), breast (5.2 %) and liver (4.2 %) cancer. The median duration from cancer diagnosis to IDDS implantation was 24 months (interquartile range [IQR] 12–48 months) and from pain onset to IDDS implantation was 6 months (IQR 2–12 months). In addition, the median oral morphine equivalents (OME) daily dose was 290 mg (IQR 100–632 mg). Mean NRS was 7.5 ± 0.8 before implantation and decreased to an average of 3.0 ± 1.1 after IDDS (p < 0.001). Median overall survival after IDDS implantation was 3 months (IQR 2–6 months). Overall, 75 % family members of cancer patients were satisfied with IDDS in relieving cancer pain. ConclusionIDDS therapy is a valuable option for patients suffering from cancer pain. More and more cancer pain patients receive IDDS to treat pain during the 3-year study period.

Use of CYP2D6 substrates and inhibitors during pain management with analgesic opioids: Drug-drug interactions that lead to lack of analgesic effectiveness

BackgroundSeveral opioids have pharmacogenetic and drug-drug interactions which may compromise their analgesic effectiveness, but are not routinely implemented into supportive pain management. We hypothesized that CYP2D6 phenotypes and concomitant use of CYP2D6 substrates or inhibitors would correlate with opioid analgesic outcomes. Materials and MethodsAn observational cross-sectional study was conducted with 263 adult chronic non cancer pain (CNCP) patients from a real-world pain unit under long-term CYP2D6-related opioid treatment (tramadol, hydromorphone, tapentadol or oxycodone). Metabolizer phenotype (ultrarapid [UM], normal [NM], intermediate [IM] or poor [PM]) was determined by the CYP2D6 genotype. The socio-demographic (sex, age, employment status), clinical (pain intensity and relief, neuropathic component, quality of life, disability, anxiety and depression), pharmacological (opioid doses and concomitant pharmacotherapy) and safety (adverse events) variables were recorded. ResultsThe whole population (66 % female, 65 (14) years old, 70 % retired and 63 % attended for low back pain) were classified as PM (5 %), IM (32 %), NM (56 %) and UM (6 %). Multiple linear and logistic regressions showed higher pain intensity and neuropathic component at younger ages when using any CYP2D6 substrate (p = 0.022) or inhibitor (p = 0.030) drug, respectively, with poorer pain relief when CYP2D6 inhibitors (p=0.030) were present. ConclusionThe concomitant use of CYP2D6 substrates or inhibitors during opioid therapy for CNCP may result in lack of analgesic effectiveness. This aspect could be relevant for pharmacological decision making during CNCP management.

ABCB1 genetic polymorphisms affect opioid requirement by altering function of the intestinal P-glycoprotein

The association between polymorphisms of the human ATP binding cassette subfamily B member 1 (ABCB1) gene and opioid response has attracted intense attention recently. As the ABCB1 gene encodes for the transporter P-glycoprotein in the brain and intestine involved in the pharmacokinetics of opioids, we investigated the effects of ABCB1 genetic polymorphisms on doses of opioids for pain relief and determined which pharmacokinetic process was affected in cancer pain patients. Sixty-eight cancer pain patients admitted for intrathecal therapy (ITT) were included. The association between ABCB1 genetic polymorphisms (C3435T, C1236T, G2677T/A and A61G) and systemic doses of opioids before ITT were investigated. Concentrations of oxycodone in plasma and cerebrospinal fluid (CSF) were determined by HPLC-MS/MS in 17 patients treated with oral oxycodone before ITT, and the influences of ABCB1 genetic polymorphisms on plasma-concentration to oral-dose ratios and CSF-concentration to plasma-concentration ratios of oral oxycodone were further analyzed. ABCB1 C3435T and G2677T/A polymorphisms were significantly associated with systemic doses of opioids before ITT, which coincided with the influences of ABCB1 C3435T and G2677T/A polymorphisms on the ratios of plasma-concentration to oral-dose. However, no significant difference was found in ratios of CSF-concentration to plasma-concentration among ABCB1 SNP genotypes. The present study provided the first evidence that ABCB1 C3435T and G2677T/A polymorphisms affect opioid requirement in cancer pain patients via altering transportation function of P-glycoprotein in the intestine, which will further expand our knowledge about pharmacokinetics of opioids and could contribute to the individualization of opioids use.

Evaluation of Pharmacotherapy of Cancer Pain in Patients with Head and Neck Cancer at a Tertiary Care Teaching Hospital

Background Head and Neck Cancers (HNC) account for 5% of all malignant tumours, but 80% of patients experience pain. As per the WHO analgesic ladder, analgesics are a cornerstone for the management of pain in HNC patients. Purpose Our study aims to analyse the prescribing pattern of analgesic drugs in patients with HNC pain. Materials and Methods A prospective, continuous, observational study was conducted among patients with HNC pain. Demographics, detailed history of pain (type, duration, location and Numerical Rating Scale [NRS] score), details of drugs prescribed and any adverse drug reactions (ADRs) were recorded at baseline visit and at first, second and sixth month follow-up. Descriptive statistics were used to analyse the above parameters. The mean reduction in NRS was analysed by the Z test. Results Out of 145 patients, 118 (81.37%) were male and 27 (18.62%) were female. The mean age of patients was 51.89 + 7.07 years. Tramadol (81.37%) followed by morphine (62.75%) were the commonly prescribed analgesics. Amitriptyline (20%) followed by pregabalin (19.31%) were commonly prescribed adjuvant analgesics. A statistically significant reduction in mean NRS was found at each follow-up visit ( p &lt; .05). A total of 50 ADRs were observed. Constipation (38%) and drowsiness (24%) were the most frequently reported ADRs, with morphine and tramadol being the most common suspected causal drugs. Conclusion Tramadol and morphine were frequently prescribed analgesics in patients with HNC pain in accordance with the WHO analgesic ladder. The majority of patients with HNC pain achieved a significant reduction in NRS pain scores at the end of six months.

Risk Factors Associated with Postoperative Cerebrospinal Fluid Leaks After Intrathecal Drug Delivery System and an External Pump Implantation in Cancer Patients: A Retrospective Study.

To determine risk factors associated with postoperative cerebrospinal fluid leaks (CSFLs) after intrathecal drug delivery system (IDDS) and external pump implantation. The clinical data of 248 patients with advanced cancer who underwent IDDS implantation from January 2021 to December 2022 at the Department of Pain Medicine at the Hunan Cancer Hospital were retrospectively reviewed. Information regarding age, gender, height, weight, body mass index (BMI), tumour type, albumin levels, haemoglobin levels, history of diabetes and pre- and postoperative anti-tumour therapy was collected and analysed. Postoperative CSFLs occurred in 7 of 231 patients (3.30%). Statistical analysis indicated that gender, age, height, weight, BMI, tumour type, albumin levels, haemoglobin levels, history of diabetes, pre- and postoperative chemotherapy, pre- and postoperative radiotherapy, preoperative immunotherapy and postoperative targeted therapy were not independent factors for CSFLs. Preoperative targeted therapy [odds ratio (OR): 16.64; 95% confidence interval (CI): 1.42, 195.56; P = 0.01] and postoperative immunotherapy (OR: 13.38; 95% CI: 1.60, 111.65; P = 0.017) were factors associated with an increased postoperative CSFL rate. Of the two locations where CSFLs can occur, the back (puncture site of catheter, n = 4) and the hypochondriac region (location of infusion port implanted, n = 3), back CSFLs occurred earlier than in the hypochondriac region (18.25 ± 6.45 vs 115 ± 62.02 days, P = 0.032). Based on the data from our study, the timing of preoperative targeted therapy and postoperative immunotherapy should be considered to prevent the occurrence of CSFLs in cancer pain patients who have an IDDS and external pump.

Safety and Efficacy of Combined Injection of Pure-μ-Opioid Agonist with Tramadol as an Opioid Induction Agent for Opioid-Naïve Cancer Patients.

Tramadol is known to provide synergistic analgesia when used in combination with morphine. The aims of this study were: (1) to introduce an opioid combination therapy using pure-μ-opioid receptor agonist (OPI) + tramadol injections (OPI + tramadol) and (2) to elucidate safety and efficacy of this combination therapy for opioid-naïve cancer pain patients. Opioid-naïve patients referred to our palliative care team (in Japan) who were unable to take oral medications and received OPI + tramadol as opioid induction agents were retrospectively investigated on the electric medical chart. OPI + tramadol dosage was adjusted to achieve the patient's pain as Numerical Rating Scale ≤4/10 or Support Team Assessment Schedule-Japanese ≤1. Patients' demography, doses of OPI and tramadol administered, and adverse events were analyzed. A total of 44 patients were included. The primary organs of malignancy were pancreas (11), stomach (5), lung (4), breast (4), liver (4), and others (13). OPI injections administered were hydromorphone (39), morphine (6), oxycodone (1), and fentanyl (1). The starting doses of OPI (morphine equivalent) and tramadol were 6.05 ± 1.63 and 67.8 ± 13.6 mg/day, respectively, and the final doses of OPI (morphine equivalent) and tramadol were 8.14 ± 3.85 and 80.0 ± 28.5 mg/day, respectively. Treatment goals were achieved in all patients. There were three patients in whom OPI was switched owing to inadequate analgesia and no new side effects other than those known to occur when OPI or tramadol is administered appeared. The results suggest that this innovative and unique opioid therapy can be safely and effectively introduced to opioid-naïve cancer patients who are relatively close to the end of life.

Pain Intensity and Satisfaction of Pain Relief in Discharged Cancer Patients: A Large Sample Study in China

Many studies have focused on the quality of pain management in hospitalized patients with cancer pain, while what happens after discharge remains unclear. The purpose of this study was to investigate the pain intensity and satisfaction of pain relief among a large sample of Chinese patients with cancer pain after discharge. Cross-sectional, descriptive, correlational research. ABOUT: 1,013 patients were recruited in a tertiary cancer hospital, and their residence addresses were distributed in 6 geographical regions, including 26 provinces, municipalities, and autonomous regions. The 1,013 patients with cancer pain were discharged from the wards of a national cancer hospital in China from July 2020 to October 2021. A nurse in the pain clinic followed the patients based on a whole-process information system and collected the data after the cancer pain patients were discharged. The study methods followed the STROBE guidelines. The average age of 1,013 discharged patients was 61.30 (±12.56) years. Moderate and severe background pain (BGP) was reported in 749 patients (73.94%), and more than 3 instances of breakthrough pain (BTP) in the past 24 hours were reported in 541 patients (53.41%). More severe BGP was associated with more frequent BTP (p < .01). In addition, there were 572 patients (56.47%) whose satisfaction with pain relief was lower than 70%. More severe BGP was associated with a lower satisfaction degree (r = -0.796, p < .01). Pain among discharged Chinese patients with cancer is poorly managed, and there is a low degree of satisfaction with pain relief. Nurses can do more work to assist cancer patients in managing pain more effectively by ensuring they have a plan to report and manage pain after discharge.

Storage, Disposal, and Use of Opioids Among Cancer Patients in Central China: A Multi-Center Cross-Sectional Study.

Unsafe opioid-related practices can lead to abuse, diversion, and accidental overdoses. In this study, we aimed to describe the patterns and beliefs regarding the storage, disposal, and use of opioids among Chinese patients with cancer in their home settings, which remain unclear. A multicenter cross-sectional survey was conducted in Hubei Province from October 2022 to June 2023. We collected information on the storage, disposal, and use of opioids among cancer pain inpatients in the oncology department. Logistic regression was used to estimate the factors associated with unsafe disposal and use of opioids. The survey included 221 patients with a median age of 62 years. Only 3.2% stored their opioids under lock and key, and 49.8% were unaware of proper disposal methods. Nearly one-fifth (19.5%) reported having received information on the safe storage (14.0%) and/or disposal (10.0%) of opioids. A total of 44.3% reported unsafe use by sharing (1.8%), losing (4.1%), or taking opioids at a higher dose than prescribed (42.5%). Patients who did not receive information on the safe disposal of opioids (OR = 4.57, P = .0423), had a history of alcohol use (OR = 1.91, P = .0399), and used opioids other than morphine (OR = 2.31, P = .0461) had higher odds of unsafe disposal practices. Individuals with an associate degree/bachelor's degree or above were less likely to dispose of (OR = 0.36, P = .0261) and use (OR = 0.31, P = .0127) opioids unsafely. A significant proportion of Chinese patients with cancer exhibit unsafe practices in the storage, disposal, and use of opioids. The study highlights an urgent need for implementing routine education programs and drug "take-back" initiatives to improve opioid-related practices.

Investigating the risk factors for nonadherence to analgesic medications in cancer patients: Establishing a nomogram model

ObjectiveThe substantial prevalence of nonadherence to analgesic medication among individuals diagnosed with cancer imposes a significant strain on both patients and healthcare resources. The objective of this study is to develop and authenticate a nomogram model for assessing nonadherence to analgesic medication in cancer patients. MethodsClinical information, demographic data, and medication adherence records of cancer pain patients were gathered from the Affiliated Hospital of Chengde Medical University between April 2020 and March 2023. The risk factors associated with analgesic medication nonadherence in cancer patients were analyzed using the least absolute selection operator (LASSO) regression model and multivariate logistic regression. Additionally, a nomogram model was developed. The bootstrap method was employed to internally verify the model. Discrimination and accuracy of the nomogram model were evaluated using the Concordance index (C-index), area under the receiver Operating characteristic (ROC) curve (AUC), and calibration curve. The potential clinical value of the nomogram model was established through decision curve analysis (DCA) and clinical impact curve. ResultsThe study included a total of 450 patients, with a nonadherence rate of 43.33%. The model incorporated seven factors: age, address, smoking history, number of comorbidities, use of nonsteroidal antiinflammatory drugs (NSAIDs), use of opioids, and PHQ-8. The C-index of the model was found to be 0.93 (95% CI: 0.907–0.953), and the ROC curve demonstrated an AUC of 0.929. Furthermore, the DCA and clinical impact curves indicate that the built model can accurately predict cancer pain patients' medication adherence performance. ConclusionsA nomogram model based on 7 risk factors has been successfully developed and validated for long-term analgesic management of cancer patients.

Prevalence of abnormal urine drug tests during COVID-19 pandemic in the cancer patient population: retrospective study.

Background: Opioid misuse is a persistent concern, heightened by the COVID-19 pandemic. This study examines the risk factors contributing to elevated rates of abnormal urine drug tests (UDTs) in the cancer pain patient population during COVID-19. Materials & methods: A retrospective chart review of 500 patient encounters involving UDTs at a comprehensive cancer center. Results: Medication adherence rates increase when UDTs are incorporated into a chronic cancer pain management protocol. Higher positive tests for illicit or nonprescribed substances in patients with specific risk factors: current smokers (tobacco), no active cancer and concurrent benzodiazepine use. Conclusion: This research emphasizes the increased risk of opioid misuse during COVID-19 among cancer pain patients with specific risk factors outlined in the results.

Cancer pain patients do not successfully handle opioids.

To evaluate patterns of opioid handling as well as their associated -variables. A transversal study. Institutional care. One hundred cancer pain patients aged 18 and above at diagnosis. Open and dichotomous questions related to opioid handling and a depression-anxiety scale. The percentage of patients who properly handled opioids. Of those surveyed, 42.1 percent of patients reported receiving opioid storage instructions, 73 percent did not receive any instructions related to proper opioid return/disposal, and 39 percent wrongly discarded them. The mean of patients with anxiety symptoms was 6.95 and of depression symptoms was 8.19. The Hebrew Version of the Hospital and Anxiety Scale total mean was 15.1. A significant relationship among patients with poor disposal habits was also found. Despite being aware of opioid's danger, patients' attitudes evidenced a poor safety responsibility. We believe that this might be due to the high percentage of disinformation and the influence of psychological symptoms on patients' decision-making.

Application of a WeChat Mini Program to provide pharmaceutical care for cancer pain patients: A randomized controlled trial.

This study aimed to develop an individual WeChat Mini Program to provide pharmaceutical care to better manage cancer pain patients and to evaluate its feasibility and the differences in analgesic efficacy, medication adherence and safety versus conventional pharmacy interventions. In this parallel randomized clinical trial, 42 cancer pain patients were equally allocated into the experimental group and the control group. The experimental group received individualized pharmaceutical care based on the "Yao Nin You Wo" WeChat Mini Program, while the control group received conventional care during the 4-week period. Main outcomes contained pain scores, medication adherence, incidences and relief rates of breakthrough pain, and incidences of adverse events. Relief rates of pain were also calculated according to pain scores. At the beginning of intervention, none of the pain scores and medication adherence showed relevant differences between the two groups (all P > .05). After intervention, the experimental group had significantly lower pain scores compared to the control group (P = .003). Breakthrough pain of both groups was alleviate; not only the incidence of breakthrough pain considerably was lower at 4 weeks than at baseline, but the relief rate of breakthrough in the experimental group was higher than that in the control group. Compared with the control group, the medication adherence rate of the experimental group was significantly improved (P = .02). Types of adverse events that happened in experimental and groups were similar, but the total incidence of adverse events in the experimental group was lower than that in the control group. WeChat Mini Program is a useful and facilitative tool with the potential to improve cancer pain self-management ability in discharged patients. In addition, pharmacists could play a key role through the Mini Program to connect with patients successfully by providing personalized pharmaceutical services.

Effectiveness of epidural morphine for the treatment of cancer pain in patients with gastrointestinal neoplasm-a systematic review.

One-third of cancer pain patients do not experience adequate pain relief using analgesic ladder by the World Health Organization. Interventional procedures, such as epidural morphine, have been considered. This study aimed to review the literature comparing the effects of epidural administration of morphine with the oral route. This systematic review included randomized controlled trials (RCTs) conducted with patients with gastrointestinal neoplasm. A search was conducted on PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, and CINAHL databases to identify studies published up to May 2023. The retrieved study was evaluated using the Risk of Bias 2 (RoB 2) tool and qualitatively synthesized. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach (Prospero: CRD42021264728). Only one RCT, a crossover trial, was included in this systematic review. The study was conducted with ten participants (one withdrawal) and reported a statistically significant difference between both subcutaneous and epidural morphine solutions and oral morphine. The adverse events were not described. The included study presents some concerns of bias and low certainty of evidence on the effectiveness and security of epidural morphine administration. The available literature does not suffice to elucidate whether morphine administration via the epidural route is more effective than other routes. Further RCTs are necessary to improve the level of evidence on the effectiveness and risk-benefit of epidural morphine in the management of cancer pain in gastrointestinal neoplasm patients.